Pancreaticoduodenectomy with Non-Reconstruction of the Remnant Pancreas in Patients with Fat Replacement of the Pancreatic Tail: A Report of Two Cases

Case 1: The patient was a 47-year-old woman who underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for suspected pancreatic cancer. The pancreatic tail was replaced by fat and the main pancreatic duct was not identified in the remnant pancreatic segment; therefore, the pancreatic segment was sutured without pancreaticojejunal anastomosis, and the upper intestine and pancreatic parenchyma were closely sutured. The patient was discharged on postoperative day 33 without evidence of endocrine dysfunction, although postoperative pancreatic juice leakage was observed. She has had no recurrence for 2 years and 5 months postoperatively, with good glucose tolerance. Case 2: The patient was a 46-year-old man with a history of chronic pancreatitis who underwent SSPPD for a pancreatic neuroendocrine tumor. The pancreatic parenchyma was replaced by fat and the main pancreatic duct could not be identified. Histopathological examination of an intraoperative frozen section revealed only islets of Langerhans in the specimen with main pancreatic duct regression; therefore, the pancreatic parenchyma was sutured closed and the remnant pancreas was left intact. Postoperatively, only a mild decrease in serum C-peptide was observed and the patient was administered Humalog 2-2-2 with regular follow-up. In patients who undergo pancreaticoduodenectomy for fat replacement of the pancreatic tail, pancreatectomy with pancreatic remnant preservation may achieve better glucose tolerance than total pancreatectomy. This is because the former procedure ensures that the islets of Langerhans remain intact as far as possible.